CMS-10620 Online Survey

LAN 2020 APM Survey
Start of Block: Landing Page
2020 Alternative Payment Models Survey
Overview
The Health Care Payment Learning and Action Network's (LAN) goal is to bring together private
payers, providers, employers, state partners, consumer groups, individual consumers, and other
stakeholders to accelerate the transition to alternative payment models (APMs).
To measure
the nation's progress, the LAN launched the National APM Data Collection Effort in 2016. This
workbook will be used to collect health plan and state Medicaid agency data according to the
Refreshed APM Framework and by line of business to be aggregated with other plan
responses.
Contact Information If you have any questions, please view the Frequently Asked Questions
or email Andréa Caballero at [email protected]
Helpful Hover Over Definitions and Explanations
Throughout the assessment you will see text highlighted in blue. You may hover your cursor
over the highlighted text to see further explanations or definitions that accompany the text. Feel
free to hover your cursor over the example below.
Example Hover Over Text
Please Respond by July 24, 2020
End of Block: Landing Page
Start of Block: General

Page 1 of 17

Provide organization name, primary contact name, email and phone for the payer respondent.

o Name of organization: ________________________________________________
o Your full name: ________________________________________________
o Your work email address: ________________________________________________
o Your work phone number: ________________________________________________
Please select the lines of business in which your organization operated in Calendar Year (CY)
2019. (Select all that apply)

▢
▢
▢

Commercial
Medicare Advantage
Medicaid

What was the total number of members covered by the payer by line of business in CY 2019?

Commercial

Medicare Advantage

Medicaid

⊗Total number of
members

Page 2 of 17

What was the payer's total health care spend (in- and out-of-network) by line of business in CY
2019?

Commercial

Medicare Advantage

Medicaid

⊗Total health care
spend

End of Block: General
Start of Block: APM Instructions
Instructions
Goal/Purpose = Track total dollars paid through legacy payments and alternative payment
models (APMs) in calendar year (CY) 2019 or most recent 12 months for which data are
available. The goal is NOT to gather information on a projection or estimation of where the
payer would be if their contracts were in place the entire calendar year. Rather it is based on
what the payer actually paid in claims for the specified time period.
Methods Payers should report the total dollars paid, which includes the base payment plus
any incentive, such as fee-for-service with a bonus for performance (P4P), fee-for-service and
savings that were shared with providers, etc.
To the extent payment to a provider includes multiple APMs, the payers should put the dollars
in the dominant APM, meaning the most advanced method. For example, if a provider has a
shared savings contract with a health plan and the provider is also eligible for performance
bonuses for meeting quality measures (P4P), the health plan would report the FFS claims,
shared savings payments (if any), and the P4P dollars in the shared savings subcategory
(Category 3A).
For more information, please see the Frequently Asked Questions or email Andréa Caballero at
[email protected]
Metrics Please note that the dollars paid through the various APMs are actual dollars paid to
providers in CY 2019 or most recent 12 months. The dollars reported for each payment model
serve as numerators to track the percentage of total dollars (the denominator) across the
different APM subcategories. Numerators should not be calculated based on members

Page 3 of 17

attributed to APMs unless the provider is held responsible for all care (in network, out of
network, inpatient, outpatient, behavioral health, pharmacy) the patient receives.
End of Block: APM Instructions
Start of Block: APM Models In Effect

Page 4 of 17

What payment models were in effect during the specified period of reporting?
Commercial

Medicare Advantage

Medicaid

Legacy Payments

▢

▢

▢

Foundational
spending to improve
care

▢

▢

▢

Fee-for-service plus
pay-for-performance

▢

▢

▢

Traditional shared
savings

▢

▢

▢

Utilization-based
shared savings

▢

▢

▢

Fee-for-servicebased shared risk

▢

▢

▢

Procedure-based
bundled/episode
payments

▢

▢

▢

Condition-specific,
population-based
payments

▢

▢

▢

Condition-specific
bundled/episode
payments

▢

▢

▢

Population-based
payments that are
NOT conditionspecific

▢

▢

▢

Full or percent of
premium populationbased payments

▢

▢

▢

Integrated finance
and delivery
programs

▢

▢

▢
Page 5 of 17

Commercial Line of Business
Please list the total dollars paid through each of the payment models that were in effect in your
organization's commercial line of business in 2019.
Note: To the extent payment to a provider includes multiple APMs, the payers should put the
dollars in the dominant APM, meaning the most advanced method. Therefore, there may be
some payment models that were in effect but do not have dollars associated as they were not
the dominant APM in the arrangement with the provider.
Legacy Payments : _______
Foundational spending to improve care : _______
Fee-for-service plus pay-for-performance : _______
Traditional shared savings : _______
Utilization-based shared savings : _______
Fee-for-service-based shared risk : _______
Procedure-based bundled/episode payments : _______
Condition-specific, population-based payments : _______
Condition-specific bundled/episode payments : _______
Population-based payments that are NOT condition-specific : _______
Full or percent of premium population-based payments : _______
Integrated finance and delivery programs : _______
Total : ________

Medicare Advantage Line of Business
Please list the total dollars paid through each of the payment models that were in effect in 2019
in your organization's Medicare Advantage line of business.
Note: To the extent payment to a provider includes multiple APMs, the payers should put the
dollars in the dominant APM, meaning the most advanced method. Therefore, there may be

Page 6 of 17

some payment models that were in effect but do not have dollars associated as they were not
the dominant APM in the arrangement with the provider.
Legacy Payments: _______
Foundational spending to improve care: _______
Fee-for-service plus pay-for-performance: _______
Traditional shared savings: _______
Utilization-based shared savings: _______
Fee-for-service-based shared risk: _______
Procedure-based bundled/episode payments: _______
Condition-specific, population-based payments: _______
Condition-specific bundled/episode payments: _______
Population-based payments that are NOT condition-specific: _______
Full or percent of premium population-based payments: _______
Integrated finance and delivery programs: _______
Total (Auto Sum): ________

Medicaid Line of Business
Please list the total dollars paid through each of the payment models that were in effect in 2019
in your organization's Medicaid line of business.
Note: To the extent payment to a provider includes multiple APMs, the payers should put the
dollars in the dominant APM, meaning the most advanced method. Therefore, there may be
some payment models that were in effect but do not have dollars associated as they were not
the dominant APM in the arrangement with the provider.
Legacy Payments: _______
Foundational spending to improve care: _______
Fee-for-service plus pay-for-performance: _______
Traditional shared savings: _______
Utilization-based shared savings: _______
Fee-for-service-based shared risk: _______
Procedure-based bundled/episode payments: _______
Condition-specific, population-based payments: _______
Condition-specific bundled/episode payments: _______
Population-based payments that are NOT condition-specific: _______
Full or percent of premium population-based payments: _______
Integrated finance and delivery programs: _______
Total (Auto Sum): ________
End of Block: APM Models In Effect
Start of Block: Review Process
Page 7 of 17

Please take a moment to review your data entry.
The sum of the dollars listed for each payment model (the numerators) should account for
exactly 100% of the total dollars paid to providers in 2019 (the denominator). If the sum of the
numerators does not equal the denominator, the LAN Measurement Team will email you to
identify where dollars are missing or are double counted.

Commercial Line of Business
Total dollars reported for Commercial (denominator): ${Q5/ChoiceTextEntryValue/1/1}
Total dollars reported across the APMs in effect in the commercial market (sum of the
numerators): ${Q8/TotalSum}

Medicare Advantage Line of Business
Total dollars reported for Medicare Advantage: ${Q5/ChoiceTextEntryValue/1/2}
Total dollars reported across the APMs in effect in the Medicare Advantage market (sum of the
numerators): ${Q9/TotalSum}

Medicaid Line of Business
Total dollars reported for Medicaid (denominator): ${Q5/ChoiceTextEntryValue/1/3}
Total dollars reported across the APMs in effect in the Medicaid market (sum of the
numerators): ${Q10/TotalSum}

Page 8 of 17

For each line of business, is the denominator equal to the sum of the numerators?

o Yes
o No
Common issues for why the sum of the numerators is not equal to the denominator:
If the sum of the numerators is greater than the denominator:
Double counting of APM dollars: When a provider arrangement includes more than one type of
payment method, all dollars flowing through that arrangement should be categorized today in
the most advanced or "dominant" APM.
If the sum of the numerators is less than the denominator:
Not accounting for the underlying fee-for-service payments: Dollars categorized as an
APM Categories 2 and 3 rely on a fee-for-service architecture. Payments classified as APMs
should include the underlying fee-for-service payments in addition to any incentives, bonuses,
or savings shared with the provider.
If you are able to resolve the issue, please use the back button to edit responses. If you have
questions on how to categorize dollars, please contact Andréa Caballero at
[email protected].
End of Block: Review Process
Start of Block: Nominal Risk in Shared Risk Contracts
Understanding Nominal Risk in 3B FFS-Based Shared Risk Contracts
Instructions
Purpose = Track total dollars paid through FFS-based shared risk contracts that meet the
threshold for the LAN's nominal risk specifications. The goal is NOT to gather competitively
sensitive or contractual plan information.
Methods
Plans should report the dollars meeting the nominal risk threshold, and those that do not. The
Worksheet tab within the LAN Nominal Risk Calculation Excel file is designed to help you
discern which contracts meet the LAN's nominal risk threshold, and will aggregate dollars
accordingly (see graphic below). Alternatively, if you know that 100% of your shared risk

Page 9 of 17

contracts meet the LAN's nominal risk threshold, you can skip the worksheet and respond "yes"
to the attestation below.
If you have any questions, please view the Frequently Asked Questions or email Andréa
Caballero at [email protected]

Please refer to the plan-level data as it appears in this section of the LAN Nominal Risk
Calculation Worksheet

For all lines of business in which your organization had dollars flowing through shared risk
contracts in 2019, can you attest that 100% of those dollars meet the LAN nominal risk
threshold?

o Yes
o No
What is the plan's total dollars flowing through shared risk contracts that MEET the LAN nominal
risk threshold?

Commercial

Medicare Advantage

Medicaid

⊗Total dollars in
shared risk contracts
MEETING LAN
nominal risk
threshold

Page 10 of 17

What is the plan's total dollars flowing through shared risk contracts that DO NOT MEET the
LAN nominal risk threshold?

Commercial

Medicare Advantage

Medicaid

⊗Total dollars in
shared risk contracts
NOT MEETING LAN
nominal risk
threshold

End of Block: Nominal Risk in Shared Risk Contracts
Start of Block: APM Trends
Informational Questions
The following questions ask about the current and future state of payment reform from the
health plan’s perspective.
For the purposes of this survey, health plan refers to any type of health insurance company,
third party administrator, or health care purchaser paying for health care provisions on behalf of
a population (e.g. state Medicaid agency).

Page 11 of 17

From health plan’s perspective, what do you think will be the trend in APMs over the next 24
months?

o APM activity will increase
o APM activity will stay the same
o APM activity will decrease
o Not sure
Which APM subcategory do you think will increase the most in activity over the next 24 months?

o Traditional shared savings, Utilization-based shared savings (3A)
o Fee-for-service-based shared risk, Procedure-based bundled/episode payments (3B)
o
Condition-specific, population-based payments, Condition-specific bundled/episode
payments (4A)
o
Population-based payments that are NOT condition-specific, Full or percent of premium
population-based payments (4B)
o Integrated finance and delivery programs (4C)
o Not sure

Page 12 of 17

Which APM subcategory do you think will decrease the most in activity over the next 24
months?

o Traditional shared-savings, Utilization-based shared-savings (3A)
o Fee-for-service-based shared risk, Procedure-based bundled/episode payments (3B)
o
Condition-specific, population-based payments, Condition-specific bundled/episode
payments (4A)
o
Population-based payments that are NOT condition-specific, Full or percent of premium
population-based payments (4B)
o Integrated finance and delivery programs (4C)
o Not sure
End of Block: APM Trends
Start of Block: APM Barriers and Facilitators

Page 13 of 17

From health plan’s perspective, what are the top barriers to APM adoption? (Select up to 3)

▢
▢
▢
▢
▢
▢
▢
▢
▢
▢

Provider interest / readiness
Health plan interest / readiness
Purchaser interest / readiness
Government influence
Provider ability to operationalize
Health plan ability to operationalize
Interoperability
Provider willingness to take on financial risk
Market factors
Other (please list) ________________________________________________

Page 14 of 17

From health plan’s perspective, what are the top facilitators to APM adoption? (Select up to 3)

▢
▢
▢
▢
▢
▢
▢
▢
▢
▢

Provider interest / readiness
Health plan interest / readiness
Purchaser interest / readiness
Government influence
Provider ability to operationalize
Health plan ability to operationalize
Interoperability
Provider willingness to take on financial risk
Market factors
Other (please list) ________________________________________________

End of Block: APM Barriers and Facilitators
Start of Block: APM Outcomes
From health plan’s perspective, please indicate to what extent you agree or disagree that APM
adoption will result in each of the following outcomes.

(Please respond to each statement listed)

Page 15 of 17

Strongly
disagree
Better quality
care

Disagree

Agree

Strongly
agree

Not Sure

o

o

o

o

o

More
affordable
care

o

o

o

o

o

Improved
care
coordination

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

More
consolidation
among health
care
providers
Higher unit
prices for
discrete
services

Given that your organization operated in more than one line of business in 2019, do the
answers provided to the informational questions vary according to line of business?

o Yes
o No
Please describe how the answers vary by line of business.
________________________________________________________________
End of Block: APM Outcomes
Start of Block: Reporting burden

Page 16 of 17

Please list other assumptions, qualifications, considerations, or limitations related to the data
submission.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

How many hours did it take your organization to complete this survey by line of
business? Please report your response in hours.

Commercial

Medicare Advantage

Medicaid

⊗Hours to
complete

End of Block: Reporting burden
Start of Block: End
Congratulations! You have finished the survey. If you are ready to submit your responses and
exit the survey, please click the "Submit" button. If you wish to review your responses, you may
use the back button below or the table of contents menu in top left corner.
End of Block: End

Page 17 of 17